High Ankle Sprains

What are High Ankle Sprains?

High ankle sprains, injuries to the upper ankle ligaments above the ankle joint, often involve the syndesmosis, the fibrous connection between the tibia and fibula. These sprains differ from lower ankle sprains in severity and treatment. Early diagnosis by a physiotherapist or foot doctor is crucial.

The Nature of High Ankle Sprains

High ankle sprains, or syndesmotic injuries, present challenges due to their lack of passive ankle stability in weight-bearing, leading to long-term functional instability. The differentiation between stable and unstable high ankle injuries is critical. Stable sprains may be treated conservatively, while unstable ones often require surgery.

Causes of High Ankle Sprains

These injuries typically occur when the foot is planted and twisted outwards excessively, or when the ankle is heavily loaded and pushed into extreme dorsiflexion, common in football tackles.

Identifying Symptoms

Symptoms include pain above the ankle, especially with outward foot rotation, difficulty in walking, bruising, swelling, and inability to perform single-leg calf raises. The severity of symptoms varies with the sprain grade.

Differentiating High Ankle Sprain and Syndesmosis Injury

High Ankle Sprain

A high ankle sprain affects the ligaments connecting the tibia and fibula above the ankle. It usually results from forceful outward twisting of the foot and ankle.

Syndesmosis Injury

This broader term refers to damage to the entire syndesmosis joint, potentially including ligaments. It arises from similar mechanisms as a high ankle sprain but can encompass more trauma types.

Diagnosis and Treatment

Diagnosing High Ankle Sprains

Physiotherapists, sports doctors, or ankle surgeons assess ligament integrity and may recommend imaging tests to confirm a diagnosis. A gap greater than 2mm in the inferior tibiofibular joint indicates potential instability.

Treatment Approaches

Treatment aims to restore stability between the tibia and fibula. Physiotherapy is crucial, whether the injury is stable or requires surgery. Treatment goals include pain relief, inflammation control, regaining motion range, strengthening muscles, restoring joint proprioception and balance, and returning to normal function.

Physiotherapy Treatment Phases

Phase 1: Injury Protection and Pain Relief

Initial treatment includes RICE (Rest, Ice, Compression, Elevation), with active rest crucial. Compression bandages and elevation aid in reducing swelling, while physiotherapists may employ various techniques for pain relief. A moon boot is normally prescribed to provide support for the healing ligaments.

Phase 2: Regaining Full Range of Motion

Targeting joint range of motion, muscle length, and neural tissue motion is essential, avoiding overstretching ligaments.

Phase 3: Restoring Muscle Strength

Strengthening exercises, progressing from non-weight-bearing to full-weight-bearing, are key for dynamic ankle control.

Phase 4: Normalising Foot Biomechanics

Foot arch assessment may lead to using orthotics or specific foot stabilisation programs.

Phase 5: Restoring High-Speed, Power, Proprioception, and Agility

Addressing balance and proprioception minimises re-injury risks and prepares for sport-specific activities.

Phase 6: Return to Sport

A customised training regimen ensures a safe return to sport, focusing on speed, power, agility, and function.

Recovery and Long-Term Considerations

Recovery Timeline

Recovery times vary with injury severity, from six weeks for mild sprains to several months for severe injuries. Professional rehabilitation ensures proper healing and function restoration.

Risks of Untreated Sprains

Neglecting treatment can lead to joint stiffness, ligament laxity, muscle weakness, and increased arthritis risk. Chronic ankle sprains require more complex treatment due to established complications.

The Importance of Professional Care

High ankle sprains, if misdiagnosed or untreated, can lead to significant joint destruction, necessitating surgery. Early and appropriate intervention is essential.

Conclusion: The Role of Physiotherapy

Physiotherapy plays a pivotal role in diagnosing, treating, and rehabilitating high ankle sprains and syndesmosis injuries. Professional guidance ensures accurate assessment and tailored treatment plans, minimising long-term complications and facilitating optimal recovery.

Remember, if you suspect a high ankle sprain or syndesmosis injury, consult your physiotherapist or healthcare specialist for precise diagnosis and effective treatment. Early and professional intervention is key to a successful recovery and return to normal activity.

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